Over 1.2 million individuals received hospice care support in 2005 and nearly one-third of all U.S. deaths occurred within a hospice program. While informal caregivers are essential to the delivery of hospice home services, they face many challenges and unmet needs in this role. Caregivers rate communication as essential to the role support they receive from hospice providers and perceive the telephone as an "emergency back-up tool" in pain and symptom management. Caregivers have associated good provider communication with good hospice experiences and poor provider communication as one of the largest barriers to providing effective end-of-life care. This mixed methods project proposes to use videophones in after-hours hospice calls to enhance end of life care for hospice patients and their family caregivers. Preliminary research has suggested that clinician - caregiver communication could be enhanced by the use of videophone technology in hospice care (telehospice) but such a tool has not been tested in after-hours triage calls. By using videophone technology in after-hours calls, it is expected that the visual connection will improve nurse-caregiver/-patient communication and increase caregiver self-efficacy in pain and symptom management thereby improving quality of life for both the caregiver and their patient. The purpose of this project is to test an intervention to improve end of life care for hospice patients and their family caregivers through the use of video-phone technology in after-hours triage services. Qualitative methods will be used to explore and compare the differences in usual care (telephone only) and videophone communication between after-hours triage nurses and family caregivers or patients and existing, validated instruments (quantitative) will be used to examine if videophone triage communication improves pain and symptom management and caregiver and patient quality of life (QOL). Specific patient measures include: self-reported pain and QOL. Caregiver measures include: anxiety, pain medication administration concerns, self-efficacy in pain and symptom management, and QOL. The project supports an ongoing research call to improve pain management and end-of-life care. PUBLIC HEALTH RELEVANCE: In 2005, more than 1.2 million Americans received hospice care, and nearly one-third of all U.S. deaths occurred within a hospice program. Significant pain is common among terminally-ill patients, but effective pain control can be difficult and stressful for these patients and their informal caregivers. We will explore if using a videophone for after-hours phone calls between hospice nurses and family caregivers leads to better caregiver and patient management of pain and higher levels of quality of life for both.